Assessment of the Respiratory Sys

Question 1

Assess smoking habits
Promote smoking cessation
Determine exposure to other inhalation irritants
Protect the respiratory system

Answer 1

Health promotion and maintenance

Question 2

Smoking at very high risk for resp diseases, comps, etc
Big thing assess on pats for smoking history
Current smoker or ever smoked? - prior smoker, when quit, how many years ago, how much did they smoke when they smokes
Record the smoking history in pack-years
Secondhand smoke and thirdhand smoke - indicated higher risk; common ask if exposed to smoke in home
Other:
Smoking history always really big

Answer 2

Assess smoking habits

Question 3

Record the smoking history in pack-years

Answer 3

years smoked x packs smoked

Question 4

Hookah or water pipes; E-cigarettes (more prevalent - help get off nicotine and tobacco but not lot evidence on what can do to lungs but need to assess this as well)

Answer 4

Other:

Question 5

Joint commission requirement - smoking is with JCHO if current smoker talk about smoking cessation - offer resources for quitting
Nicotine replacement therapies - lot available but is very hard

Answer 5

Promote smoking cessation

Question 6

Nicotine replacement therapies - lot available but is very hard

Answer 6

Ex. Zyban - med; Chantix - med; Nicotine patch, lozenges, gum

Question 7

Current and past geographic living area
Occupation
Home conditions
Hobbies

Answer 7

Determine exposure to other inhalation irritants

Question 8

Areas with high levels of air pollution
Exposure to inhalation irritants

Answer 8

Protect the respiratory system

Question 9

Areas with high levels of air pollution

Answer 9

Teach patients to remain indoors with windows closed when air quality is poor and to not to engage in heavy physical activity

Question 10

wear masks and ensure the area is well ventilated

Answer 10

Exposure to inhalation irritants

Question 11

Everything worsens with age
Alveoli
Lungs
Pharynx and larynx
Pulmonary Vasculature
Exercise Tolerance
Muscle Strength
Susceptibility to Infection
Chest wall

Answer 11

Changes in the resp sys related to aging - things happen with aging

Question 12

alveolar surface area decreases - because decrease SA for gas exchange can affect resp sys for exchange of O2 and CO2
Where gas exchange occurs
diffusion capacity decreases
elastic recoil decreases - less recoil: air can get trapped in lungs because not exhaled as efficiantly
bronchioles and alveolar ducts dilate - dilation in airways
ability to cough decreases - decreased cough reflexes
airways close early

Answer 12

Alveoli

Question 13

residual volume increases - loss elasticity because of it; not as much exhale air out so get increase RV; not go thing because not want lot of it
vital capacity decreases - amount air can breathe in and out decreases
efficiency of oxygen and carbon dioxide exchange decreases
elasticity decreases

Answer 13

Lungs

Question 14

Upper airway; swallowing affected because not have much strength; little bit of cartilage loss can make airways collapse
muscles atrophy - weaker
vocal cords become slack
laryngeal muscles lose elasticity
airways lose cartilage

Answer 14

Pharynx and larynx

Question 15

Veins and arteries that supply blood to lungs and take blood away from lungs
vascular resistance to blood flow through pulmonary vascular system increases - when pumping blood out lungs more pressure in vessels and can damage lungs because harder on vessels because more resistance so get pulm HTN
pulmonary capillary blood volume decreases - less blood supply to pulm caps = less blood supply to alveoli (where gas exchange is)
risk for hypoxia increases and hypercapnia (High CO2 and low O2)

Answer 15

Pulmonary Vasculature

Question 16

body’s response to hypoxia and hypercarbia decreases - because issues high CO2 and low O2 this decreases

Answer 16

Exercise Tolerance

Question 17

respiratory muscle strength, especially the diaphragm and the intercostals, decreases
Decreases in whole body and resp muscles in intercostal spaces and diaphragm

Answer 17

Muscle Strength

Question 18

effectiveness of the cilia decreases
immunoglobulin A decreases
alveolar macrophages are altered

Answer 18

Susceptibility to Infection

Question 19

anteroposterior diameter increases
thorax becomes shorter
progressive kyphoscoliosis occurs
chest wall compliance (elasticity) decreases
mobility of chest wall may decrease
osteoporosis is possible, leading to chest wall deformities

Answer 19

Chest wall

Question 20

Doing assessment ask questions and phys assessment
Family and personal data
Smoking
Drug use (prescribed and recreational that could affect lungs) - meds
Allergies esp for resp assessment for asthmatic pat (hypersensitivity rxn - have lot triggers related to allergies); emphysema/chronic lung pat exposed to something that causes upper resp distress exacerbate lung probs
Travel, geographic area of residence - travel to area with increased pollutants or live in area like that
Nutritional status - imp
Current health problems

Answer 20

History

Question 21

Is the current health problem acute or chronic? - chronic lung probs or is this an acute sit
Question the patient about cough: - big thing about is sputum - know amount, thick/thin, sticky, color
chest pain
Dyspnea - SOB
Related to resp assessment

Answer 21

Current health problems

Question 22

Productive or Non productive
What does the sputum look like? How much?

Answer 22

Question the patient about cough: - big thing about is sputum - know amount, thick/thin, sticky, color

Question 23

Complete physical assessment via inspection and auscultation of lungs (auscultate lung sounds) - if find have pulm issues may do percussion/palpation - higher level practitioner level assessment because another way to assess lungs to assess for dullness and see changes in lung field area
Auscultation
Skin and mucous membrane changes (pallor, cyanosis)
General appearance
Endurance

Answer 23

Assessment

Question 24

Lungs clear - great
Diminished - means something going on; not as much air movement going on; pneumonia/consolidation
Wheezes - asthmatic or constriction
Crackles - fine/coarse
Rhonchi - coarse crackles: secretions
Rales - fine crackles: more fluid type situation
Sound lungs good idea what going on with pat

Answer 24

Auscultation

Question 25

Assess the nail beds and mucous membranes of the oral cavity Skin give good indication Cyanosis - hypoxemia going on and not getting blood supply to the tissues; check nail beds, mucous membranes/skin Examine fingers for clubbing (indicate long-term hypoxia); angle nail not as sharp and may indicate long-term chronic lung probs

Answer 25

Skin and mucous membrane changes (pallor, cyanosis)

Question 26

Long-term respiratory problems lead to weight loss and a loss of general muscle mass Arms and legs may appear thin or poorly muscled Neck and chest muscles may be hypertrophied - will use accessory muscles to breathe - upper muscles used more often Chronic lung prob: certain disease processes: bloated/fluid retention; typ emaciated, thin, working harder to breathe - higher caloric needs; breathing so hard that not eating as well; had choice eating and breathe and pacing self will breathe; issues with weight loss and muscle mass decreases

Answer 26

General appearance

Question 27

Decreases whenever gas exchange is inadequate Observe how easily the patient moves and whether the shortness of breath is at rest or upon exertion; good assessment is SOB: worse if SOB at rest than with activity - make distinction, SOB when laying flat Note how often the patient pauses for breath between words when talking; if pat has to stop when talking to take a breath are SOB; if notice breathing are SOB - pay attention to it means SOB

Answer 27

Endurance

Question 28

Sputum imp assessment to look at: how much coughing up, when coughing it up; blood - keep track actual volume - thick, thin, watery Sometimes hear secretions Cough: productive/nonproductive Productive: what looks like Having secretions but is their cough production strong enough to get it out

Answer 28

Secretions

Question 29

Imp for resp pats Shortness of air often induces anxiety (supposed to be breathe and not notice it so when breathe and notice it makes very anxious) and anxiety can exacerbate shortness of air - vicious cycle so want keep pats relaxed and be cognisant that are anxious; pat pop where controlling anxiety imp; sometimes need take antianxiety - benzodiazepene - conscious of giving those meds because can be sedating which can affect breathing; if chronic lung prob need cognisant of anxiety levels and keeping them as low as possible can Stress may worsen some respiratory problems Discuss coping mechanisms esp if chronic thing - so disabled from SOB that cannot care for self anymore; find resources for them to be able to get the help they need Chronic respiratory disease Assist the patient to identify available support systems

Answer 29

Psychosocial assessment

Question 30

Chronic respiratory disease

Answer 30

changes in family roles or relationships social isolation financial problems/unemployment Disability

Question 31

Red blood cell count (RBC) Hemoglobin White Blood Cell count (WBC) with Diff Arterial blood gases (ABG) Sputum Chest x-rays CT Chest (computerized tomography)

Answer 31

Laboratory and imaging assessment

Question 32

Data about the transport of oxygen - imp assessment

Answer 32

Red blood cell count (RBC)

Question 33

Transports oxygen to the tissues - imp assessment Low hemo - anemia can affect O2 because not as much hemo carrying O2 around Deficiency could cause hypoxemia

Answer 33

Hemoglobin

Question 34

Good Indication of infection

Answer 34

White Blood Cell count (WBC) with Diff

Question 35

Data on oxygenation as well as acid base balance - blood drawn from arterial blood stream and gives indic of oxygenation and acid base balance: PO2, PCO2, bicarbonate, pH; indices adequate gas exchange, getting rid CO2 and getting O2 in

Answer 35

Arterial blood gases (ABG)

Question 36

Culture and sensitivity - pneumonia, sputum Cytology - concerned about pathology (like lung cancer); run on sputum Productive cough - target antibiotics

Answer 36

Sputum

Question 37

Pneumonia - first thing do if think this Very common diagnostic tool - chest pain, resp, SOB get this Preliminary tool; go to Typically one of the first tools

Answer 37

Chest x-rays

Question 38

Typ With contrast (concerned for allergies and kidney func) or sometimes without Better pics for masses

Answer 38

CT Chest (computerized tomography)

Question 39

Assess for oxygenation Identifies measurement hemoglobin saturated with oxygen Readings recorded as SpO2, SaO2 or O2 sat(uration) Normal: 95% - 100%: no issues 98-100 Below 91% Below 85% Pats with chronic COPD, emphysema - keep oxygenation and SpO2 lower level - sometimes chronic lung pats goal between 88-92; deals with hypoxic vasoconstriction; sometimes consideration where retain CO2 and issues with alveolar damage keep SpO2 at lower level Able to detect desaturation before other manifestations occur (dusky skin, pale mucosa, pale or blue nail beds)

Answer 39

Pulse oximetry

Question 40

require immediate assessment and do interventions/treatment

Answer 40

Below 91%

Question 41

body tissues have a difficult time becoming oxygenated - very concerning

Answer 41

Below 85%

Question 42

Capnometry and Capnography - measuring exhaled CO2; good indic of ventilation; see if too sedated and hypoventilating Some Oxygen cannulas - measure exhaled CO2 Pulmonary function tests (PFTs) Exercise testing Skin tests

Answer 42

Other noninvasive diagnostic assessments

Question 43

Often in outpat setting if eval someone for obstructive/restrictive lung disease: COPD/asthma/pulm fibrosis: things restrict/obstruct airway Lot measurements of volume RTs run these These 3 need look at as nurse Forced vital capacity (FVC) Forced expiratory volume (FEV1) Peak expiratory flow (PEF) Good measurements for obstructions/restrictions in airway

Answer 43

Pulmonary function tests (PFTs)

Question 44

Volume of air exhaled from full inhalation to full exhalation Air fully inhale and fully exhale - indication if airway restricted/obstructed because numbers decreased

Answer 44

Forced vital capacity (FVC)

Question 45

Volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest inhalation Look across board from chronic COPD pats; take deepest breath can and blow out as hard and as fast as possibly can and measure volume air comes out in first sec COPD pats have issue with getting rid RV because alveolar damage - trapping air not able fully exhale so exhalation good measurement for obstructive diseases because obstruction and not able to fully exhale

Answer 45

Forced expiratory volume (FEV1)

Question 46

Fastest airflow rate reached at any time during exhalation How fast exhale

Answer 46

Peak expiratory flow (PEF)

Question 47

More outpat

Answer 47

Exercise testing

Question 48

Very common Allergy testing - ID tests and see what react to Tuberculin skin testing - screening

Answer 48

Skin tests

Question 49

Invasive procedure - informed consent Receive at min moderate sedation/gen anesthesia Laryngoscopy Mediastinoscopy Bronchoscopy

Answer 49

Endoscopic examinations

Question 50

Scope inserted into larynx to assess the function of the vocal cords Go look into larynx Concerned about swallowing and speech Uses: Patients receive sedation

Answer 50

Laryngoscopy

Question 51

remove foreign bodies caught in the larynx obtain tissue samples for biopsy or culture

Answer 51

Uses: - Laryngoscopy

Question 52

Insertion of a flexible tube through the chest wall just above the sternum into the area between the lungs Full gen anesthesia Uses: Performed under general anesthesia

Answer 52

Mediastinoscopy

Question 53

Examine for tumors Obtain tissue samples for biopsy or culture from mediastinum

Answer 53

Uses: - Mediastinoscopy

Question 54

Most common endoscopic exams for resp pats Insertion of a tube/scope in the airways, usually as far as the secondary bronchi; looking as far down as bronchi Uses: Very common tool because used for lots diff things such as diagnostic/intervention Rigid bronchoscopy requires general anesthesia in the OR Flexible bronchoscopy can be performed at the bedside/pulm lab/GI lab/lab outside full OR Short procedure Nursing Interventions Post Procedure: - caring for pats

Answer 54

Bronchoscopy

Question 55

View/look in airway structures Obtain tissue samples for biopsy or culture - looking for mass can biopsy Remove excessive secretions or foreign bodies - full secretions can suck out all secretions - remove foreign bodies from airways Also flush airways with saline suck saline back out and send bronchial washing down to be tested if concerned about lung cancer because lung cells in bronchial wash Assist with placing or changing endotracheal tube

Answer 55

Uses: - Bronchoscopy

Question 56

Monitor for hemoptysis - not unusual for little bit but if excessive report that Min moderate sedation so must be closely monitored during procedure and immediately post Monitor VS, O2 saturation, and assess breath sounds every 15 min for 2 hours - could puncture airway and cause bleeding in airway and cause comps so need monitor for bleeding, infection (not seen right away), issues with breathing postop give sedation checking for oxygenation as well Monitor for return of gag reflex - numb airway: larynx and pharynx not safe to eat/drink once come back from procedure so cannot eat/drink until check gag reflex Assess for possible complications of bleeding, infection or hypoxemia Can damage lung so do CXR postop to make sure no puncture of of lung

Answer 56

Nursing Interventions Post Procedure: - caring for pats - Bronchoscopy

Question 57

Where place needle into pleural space (between lung wall and pleural lining) - typ not much space between there but are times where fluid, blood, air collects in space and when that happens the lung collapses/pushes the lung down Needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes; needle in there to remove fluid; fix prob as management purposes but also for diagnostic - even if not huge amount of fluid draw little amount of fluid and test it if concerned about cancers/infection; diagnostic/treatment Nursing Interventions Post Procedure

Answer 57

Thoracentesis

Question 58

Often performed at the bedside Local anesthetic agent to numb area - wide awake so not much prep besides consent Help to position patient - lung be as expanded as much as possible; put over bedside table and hunched over in tripod position; cannot do that on side and in fetal Stress the importance not to move, cough, or deep breath during the procedure

Answer 58

Needle aspiration of pleural fluid or air from the pleural space for diagnostic or management purposes; needle in there to remove fluid; fix prob as management purposes but also for diagnostic - even if not huge amount of fluid draw little amount of fluid and test it if concerned about cancers/infection; diagnostic/treatment - Thoracentesis

Question 59

CXR to rule out possible pneumothorax (can occur within 24 hours) - Needle could go into lung to cause pneumothorax - draining fluid - hole in lung and air leaking from pleural space into lung; very common so always get CXR to make sure not occurred; if have pneumothorax - no air movement heard so lung sounds extremely diminished or absent because lung collapsed when air collected in there Monitor VS, lung sounds, bleeding at puncture site - check puncture site - typ not many comps with puncture site but need monitor it

Answer 59

Nursing Interventions Post Procedure - Thoracentesis

Question 60

Invasive Often for cancers/masses Performed to obtain tissue for histologic analysis, culture, cytologic examination - some or all May be performed: Nursing Interventions Post Procedure:

Answer 60

Lung biopsy

Question 61

In the radiology department with the help of fluoroscopy or CT guided biopsies and more common because less invasive for pat and have CT and know where exactly where going and get sample need In the OR if an open biopsy is required under general anesthesia Through a bronchoscopy Depending on how done depends on type monitoring needed

Answer 61

May be performed: - Lung biopsy

Question 62

radiology/bronchoscopy - moderate sedation - follow-up care and CXR CT or CXR to rule out pneumothorax - taking chunk for biopsy from lung could put hole in lung Follow-up care:

Answer 62

Nursing Interventions Post Procedure: - Lung biopsy

Question 63

Assess vital signs, breath sounds at least every 4 hours for 24 hours Assess for respiratory distress/issues Assess airway Report reduced/absent breath sounds immediately Monitor for hemoptysis - blood - not unusual for little bit but if excessive report that

Answer 63

Follow-up care: - Lung biopsy